Addition of Primary Metastatic Site on Bone,Brain, and Liver to IMDC Criteria in Patients With Metastatic Renal Cell Carcinoma: A Validation Study |
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| Authors: | Francesco Massari Vincenzo Di Nunno Annalisa Guida Carolina Alves Costa Silva Lisa Derosa Veronica Mollica Emeline Colomba Giovanni Brandi Laurence Albiges |
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| Affiliation: | 1. Division of Oncology, S. Orsola-Malpighi Hospital, Bologna, Italy;2. Department of Medical Oncology, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy;3. Department of Cancer Medicine, Gustave Roussy Cancer Campus, Paris-SudUniversity, Villejuif, France;4. Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy;1. School of Medicine, University of Alabama at Birmingham, Birmingham, AL;2. Department of Radiology, University of Alabama at Birmingham, Birmingham, AL;3. O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL;4. Department of Urology, University of Alabama at Birmingham, Birmingham, AL;5. Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL;6. Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL;1. Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH;2. Department of Medicine, Brigham and Women’s Hospital, Boston, MA;3. Department of Internal Medicine, Section of Hematology Oncology, Tulane University Medical School, New Orleans, LA;4. Department of Internal Medicine, Section of Hematology Oncology, Vanderbilit University, Nashville, TN;5. Department of Hematology Oncology, University Hospitals Seidman Cancer Center. Case Comprehensive Cancer Center, Cleveland, OH;1. Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China;2. Department of Interventional Radiology, The Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, China;1. Department of Urology, Keio University School of Medicine, Tokyo, Japan;2. Department of Pathology, Keio University School of Medicine, Tokyo, Japan;1. Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX;2. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX;3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX;4. Department of Biostatistics, West Virginia University School of Public Health, Morgantown, WV;1. Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan;2. Department of Medical Oncology, Sasaki Foundation Kyoundo Hospital, Tokyo, Japan |
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| Abstract: | BackgroundThe International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria have been largely adopted in clinical practice. In a recent retrospective study, we assessed that the addition of the first site of metastatic disease to brain, bone, and liver improves prognostic stratification of patients with metastatic renal cell carcinoma (mRCC). Here, we performed an external validation in patients with mRCC. Our aim was to evaluate if the addition of a new independent variable could improve IMDC prognosis prediction and reduce heterogeneity within risk categories.Patients and MethodsWe selected all 1073 patients treated at a single institution for mRCC and included in the Institute Gustave Roussy Renal Cell Carcinoma database. All patients included received at least 1 line of targeted therapy or immune checkpoint inhibitors. Univariate and multivariate analyses (Cox regression model) were performed. Bootstrap validation of the final model was also carried out for internal validation. The IMDC modified classification was defined by the addition of the seventh variable, and we defined the modified IMDC good-risk criteria as 0 risks, intermediate-risk as 1 to 2 risks, and poor-risk as 3 or more risks.ResultsThe presence of brain, bone, and/or liver as the first site of metastatic disease plus the other variables included in the IMDC score were statistically significant variables associated with overall survival (OS) after univariate and multivariate analysis and bootstrap validation. Finally, 122 (15%) patients had a modification of their initial risk category. The median OS in the poor-, intermediate-, and favorable-risk groups was 10, 26, and 52 months, respectively (P < .001). The bias-corrected concordance index in patients receiving immune checkpoint inhibitors (n = 241) was 0.71.ConclusionThe addition of brain, bone, and/or liver metastases as an additional variable to the other IMDC variables improves the prognostic predictive power of the model. |
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| Keywords: | Liver metastasis Metastatic disease Metastatic renal cell carcinoma Prognostic criteria Treatment planning |
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